title: Valgus femoral osteotomy for noncontainable Perthes hips: prognostic factors of remodeling.
abstract: BACKGROUND
  The authors have performed valgus femoral osteotomy (VFO) with rotational and sagittal components for Legg-Calvé-Perthes disease hips with hinge abduction. We analyzed skeletally mature patients to determine: (1) whether VFO improved hip function; (2) whether favorable radiographic remodeling of the hip occurred; and (3) whether any clinical or radiographic factors were associated with remodeling of femoral head deformity.
  
  
  METHODS
  Thirty-one patients (31 hips, 25 boys and 6 girls) who underwent VFO between 1986 and 2007, and subsequently followed until skeletal maturity constituted the study cohort. The mean age at surgery was 9.4 years (range, 3.5 to 15 y) and the mean age at the most recent follow-up was 20.2 years (range, 14.6 to 28.3 y). Clinical outcomes were evaluated using Iowa Hip Scores and ranges of hip motion. Radiographic outcomes were assessed with respect to the radiographic indices for femoral head deformity and subluxation. Clinical and radiographic parameters were analyzed to find correlations with the femoral head remodeling (preoperative to final follow-up changes in deformity index).
  
  
  RESULTS
  Iowa Hip Score improved from 71 (30 to 91) to 92 (76 to 100). Ranges of hip abduction, internal rotation, and external rotation increased. At last follow-up evaluations, mean Mose sphericity index of the femoral head was 4.2 mm (range, 0 to 13 mm) and femoral heads had 4 Stulberg type II, 21 type III, and 6 type IV deformity. Overall radiographic indices for femoral head deformity and subluxation did not change during follow-up period except decreased medial joint space, but greater amount of preoperative to final follow-up changes in deformity index was associated with younger age (<10 y) and earlier disease stages (fragmentation and early reossification stage) at time of surgery.
  
  
  CONCLUSIONS
  VFO modified to accommodate the various hinging patterns of Legg-Calvé-Perthes disease hips was found to beneficially improve hip function at skeletal maturity. Although overall radiographic remodeling was not definite, favorable remodeling of the femoral head can be expected when younger patients undergo this procedure at the fragmentation or early reossification stage.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
authors.forename: Won Joon
authors.initials: WJ
authors.lastname: Yoo
authors.forename: In Ho
authors.initials: IH
authors.lastname: Choi
authors.forename: Hyuk Ju
authors.initials: HJ
authors.lastname: Moon
authors.forename: Samuel
authors.initials: S
authors.lastname: Chang
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cho
authors.forename: Yoon Hyo
authors.initials: YH
authors.lastname: Choi
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Park
authors.forename: Chin Youb
authors.initials: CY
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult